The applicability of Willems' method for age estimation in southern Turkish children: A preliminary study

doi:10.1016/j.jflm.2015.11.015

Journal of Forensic and Legal Medicine

Volume 38, February 2016, Pages 24-27

https://doi.org/10.1016/j.jflm.2015.11.015 Get rights and content

Highlights

•
We evaluated the applicability of Willems' method.
•
First investigation of the applicability of Willems' method to a southern Turkish population.
•
The degree of reliability of Willems' method decreased according to CA in girls and boys in the mixed dentition stage.

Abstract

The aims of the present study were to evaluate the applicability and accuracy of Willems' method for assessing southern Turkish children and to analyze the practicability of this method in different age groups for both genders.

Panoramic radiographs of 756 children (378 females, 378 males) aged between 5 and 14.99 years were examined by one observer. This retrospective study involved a contemporary southern Turkish population. The chronological ages of the subjects were divided into 10 groups. These 10 groups consisted of children of the following ages 5 and 14.99. Relationships between continuous variables were examined using Pearson's correlation coefficient. The paired t-test was used to compare all data according to gender and age groups. A p-value of less than 0.05 was considered significant for all statistical data.

According to the results, a very high correlation was found for both girls (r² = 0.946) and for boys (r² = 0.940). Dental age (DA) and chronological age (CA) were consistent for girls in the four age groups (5–5.99, 6–6.99, 12–12.99, and 14–14.99) and for boys in the three age groups (5–5.99,13–13.99, 14–14.99).

The maturity score of Willems' Belgian samples of the DA was applicable to seven groups of the southern Turkish children. The present study reports that Willems' method is more accurate for girls than for boys.

Introduction

In the legal process, determining age is important in terms of both penalties and the law. It is particularly critical to determine whether the respective person is over 7, 12, 15, and 18 years of age in Turkey.1, 2 Knowing the person's age helps to determine his employment, school, and military recruitment status; whether he has penal and legal liability; and whether he is capable of understanding the legal meaning and consequences of the action he committed.²

If there is no accurate data for a person's age, then bones, height, and teeth can be used to determine their age.³ Dental age (DA) assessment based on dental maturity, especially pediatric dentistry and orthodontics, is one of the most reliable indicators of chronological age (CA). It is the most widely used assessment in pediatric endocrinology and in forensic, legal, and clinical dentistry.4, 5

There are various methods for establishing age based on dental tissues, including the following: morphological(dental attrition rate, tooth color changing), metrical(Carbon14 analysis, histological analysis), radiomorphological(Demirjian's methods), and radiometrical(Cameriere's methods, Mörnstaad' methods).5, 6 In terms of age estimation, teeth are divided into two main periods: primary teeth and permanent teeth.7, 8 Reliability is higher in the examination of primary teeth (formation of mineralization, neonatal line, and micrometric measurements, etc.) and thus age can be determined with low error rates.⁷ During the childhood period, there is constant change in the jaw bone because of the loss of primary teeth and the eruption, mineralization, and formation of permanent teeth. During this period, age estimation is mostly done by comparing the drawings and tables of dentition development with radiographs.9, 10 Determining the age based on bone development is the most frequently used method.¹¹

Dental tissues are less affected by endocrine disorders or by dietary differences compared to other tissues in the body.12, 13 If one of the teeth is fully mineralized, its form is stable, and developmental and retroactive variations in this status relate to CA.³ Human growth is a complex process that is mainly genetically but also environmentally determined. The body growth due to the proliferation of tissues is regulated by several environmental factors. These factors can be affected adversely by increasing consumption of processed foods, additives, toxins and environmental pollution, insufficient sunlight exposure, and inactivity.¹² Adversely affected body balance and chronic diseases (diabetes, thyroid disorders, and heart disorders) that delay dental growth have been observed among very young children.

Methods involving teeth for age estimation among children were developed by Nolla in 1960,¹⁴ by Moorrees in 1963,¹⁵ by Haavikko in 1970,¹⁶ and by Demirjian in 1973.¹⁰ These methods are all based on morphological evaluation of dental growth. The most frequently used method to determine age according to dental growth is Demirjian's method.4, 10 Dental growth in this method is described in eight stages from A to H and evaluations are made on the left lower jaw on seven molar teeth (except the wisdom teeth). A total score out of 100 for dental growth is determined by checking the respective values of the table at the growth stage of each tooth, and DA can be estimated based on the standards that have been created. As the estimations using Demirjian's method began to give over estimation results than just the CA, Willems et al. revised the method.¹⁷

Demirjian's method is based on dental maturity. However, in the studies carried out in Turkey, particularly in regions that have hot climates (Mediterranean region, Aegean region, and Middle Anatolia), Demirjian's method is valid but not fully compatible.2, 18 There is a lack of contemporary DA estimation standards for the southern Turkish population. The aims of the present study were to evaluate the applicability and accuracy of Willem's method for assessing the ages of southern Turkish children and to analyze the practicability of this method in different age groups for both genders.

Section snippets

Material and methods

In this study, 756 children were selected, including 378 males and 378 females. The panoramic radiographs were selected from child patients referred to the Faculty of Dentistry of Mustafa Kemal University in Hatay, Turkey. This retrospective study involved a contemporary Turkish population.

The inclusion criteria were as follows: aged between 5 and 14.99 years old; the quality of the panoramic radiographs was good and clear; and the subjects are free of systemic disorders, experienced a normal

Results

The present study included 756 healthy southern Turkish children, including 378 females (50%) and 378 males (50%). Age and gender distributions in the present study population are shown in Table 1. According to the results, a very high correlation was determined for both females (r² = 0.946) and males (r² = 0.940). Dental age was overestimated by 0.34 when using Willems' method. The mean differences between the chronological and dental ages ranged from −0.29 to +0.82 years for females and

Discussion

The city of Hatay, where the present study was conducted, is one of the oldest settlements of Turkey and is on the Eastern Mediterranean region. The city has a typical Mediterranean climate, with a hot and dry summer season and a warm and rainy winter season. Syria is to the east and south of the city, and Adana, Osmaniye, and Gaziantep are to the west and north of the Mediterranean. In addition, Hatay receives a significant amount of external migration from Syria due to that country's civil

Conclusion

This study is the first investigation of the applicability of Willems' method to a southern Turkish population. The maturity score of Willems' Belgian samples of the DA was applicable in seven groups of southern Turkish children. The present study reports that the Willems' method is more accurate for females than for males. We believe this preliminary study will contribute to future research studies.

Conflict of interest

none.

Funding

None declared.

Ethical approval

None declared.

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Comperative evaluation of Nolla, Willems and Cameriere methods for age estimation of Turkish children in the Central Black Sea Region: A preliminary study
2022, Journal of Forensic and Legal Medicine
Since dental age estimation methods' accuracy and reliability levels differ in each society, the method should be appropriate for societies. This study aims to evaluate the applicability of Nolla, Willems, and Cameriere methods to Turkish children in the Central Black Sea Region.
This study was conducted based on the panoramic radiographs of 400 children between the ages of 6–14 years admitted to Tokat Gaziosmanpaşa University Faculty of Dentistry, Department of Pediatric Dentistry for examination between 2016 and 2020. Nolla, Willems, and Cameriere methods estimated dental age on the selected panoramic radiographs. While 14 teeth in the left mandible and maxilla were evaluated for Nolla method, seven teeth in the left mandible were evaluated for Willems and Cameriere methods. Data were analyzed using IBM SPSS V23. The Pearson correlation coefficient was used to analyze the relationship between the chronological age (CA) and dental age (DA), and the paired sample t-test was used to analyze the difference.
A statistically significant difference was found between CA-Nolla dental age (p = 0.002), CA-Willems dental age (p < 0.001), and CA-Cameriere dental age (p = 0.033) in boys. The mean differences between dental age and chronological age in boys were −0.24 years in the Nolla method, +0.49 years in Willems method, and −0.17 years in the Cameriere method. A statistically significant difference was found between CA-Nolla dental age (p = 0.001) and CA-Willems dental age (p < 0.001) in girls. The mean differences between dental age and chronological age in girls were −0.27 years in the Nolla method, +0.76 years in the Willems method, and −0.1 years in the Cameriere method.
In this study method providing closest estimation for chronological age among children aged 6–14.99 that were examined in Central Black Sea Region, was the Cameriere method in both girls (79.9%) and boys (80.6%), followed by Nolla method and Willems method, respectively.
Age estimation in the living: A scoping review of population data for skeletal and dental methods
2021, Forensic Science International
Age estimation of living individuals has become a crucial part of the forensic practice, especially due to the global increase in cross-border migration. The low rate of birth registration in many countries, hence of identification documents of migrants, especially in Africa and Asia, highlights the importance of reliable methods for age estimation of living individuals. Despite the fact that a number of skeletal and dental methods for age estimation have been developed, their main limitation is that they are based on specific reference samples and there is still no consensus among researchers on whether these methods can be applied to all populations. Though this issue remains still unsolved, population information at a glance could be useful for forensic practitioners dealing with such issues.
This study aims at presenting a scoping review and mapping of the current situation concerning population data for skeletal (hand-wrist and clavicle) and dental methods (teeth eruption and third molar formation) for age estimation in the living.
Two hundred studies on the rate of skeletal maturation and four hundred thirty-nine on the rate of dental maturation were found, covering the period from 1952 and 2020 for a total of ninety-eight countries.
For most of the western and central African countries there are currently no data on the rate of skeletal and dental maturation. The same applies to the countries of the Middle East, as well as the eastern European countries, especially as regard the skeletal development.
A comparison of the accuracy of Willems’ and Cameriere's methods based on panoramic radiography
2019, Forensic Science International
Citation Excerpt :
Our study showed that Willems’ method overestimates dental age. There are several studies in Europe, Middle East, and India reporting very similar results to our study [6–11]. Akkaya et al. also found that Willems’ method overestimates dental age but reported slightly better mean CA-DA value than our study [12].
Tooth development evaluation is majorly the current approach to identify age and maturity. Dental age (DA) is therefore considerably emphasized in forensic and pediatric dentistry. The aim of this study was to assess the applicability of Willems and Cameriere methods for Turkish children. Panoramic images of 636 Turkish healthy children (319 male; 317 female) aged between 6 and 15 years were assessed. DA of the subjects was determined by using Willems and Cameriere methods. The seven right and left permanent lower teeth were valued using these two methods. The mean chronological age (CA) of the subjects was 11.53 ± 2.25 (min:6, max:14.99) years (boys: 11.29 ± 2.34 years, girls: 11.77 ± 2.15 years). Willems method overestimated the CA (p ≤ 0.001), in contrast, Cameriere method underestimated the CA (p ≤ 0.001) for both sexes. In different age groups the mean difference between the CA and DA calculated by Cameriere method (CADA) ranged from 0.86 to −0.41 years for boys and from 1.00 to −0.21 years for girls, while the mean difference between the CA and DA calculated by Willems method ranged from −0.26 to −0.71 years for boys and from 0.19 to −0.76 years for girls. Cameriere method provided a better percentage of accuracy (84.6% and 77.3% for males and females, respectively) in the absolute difference values within 1 year compared to Willems method. Cameriere method performed slightly better but, both methods may be used for DA estimation in the Turkish population.
Age estimation by measurement of open apices in tooth roots: Study using Saudi Arabian samples
2019, Journal of Forensic and Legal Medicine
Citation Excerpt :
However, estimating chronologic age is more complex and involves general physical examination, radiographic evaluation of skeletal and dental structures.6 Among dental tissue evaluations, age changes in tooth color, dental attrition rate, Carbon-14 levels, histologic analysis, radio-morphologic and radio-metric methods have been suggested.7–10 As compared to other tissues, radiographic evaluation of tooth development is regarded to be more accurate since development of tooth is largely influenced by genetics and to a lesser extent by nutritional and environmental factors.11
The aim of this study was to verify Cameriere's regression formula to predict chronologic age in Saudi Population and if proven to be inaccurate, develop a new algorithm specific for Saudi children. A total of 788 Orthopantamographs(495 boys and 293 girls) were analyzed. The tooth measurement parameters were: number of teeth with closed apex (N₀), open apex width (a), crown length (l), A/L ratio for each tooth (x₁to x₇) and summation of all open apex width (s). The radiographic measurements were substituted in the formula:
Age = 8.971 + 0.375g + 1.631 x₅ + 0.674 N₀ – 1.034s–0.176s * N₀
The mean dental age assessed by Cameriere's method was significantly lower than chronologic age in Saudi population and with both genders and total study population (p < 0.05). A stepwise linear regression showed all parameters gender, N₀, x₁ to x₇ except x₂significantly associated with age (R² = 0.6334, F (6,779) = 168.28, p < 0.05). There was no statistically significant difference between predicted and actual chronologic age for 788 children using regression equation for Saudi population (p = 1). Cameriere's formula verified in Saudi children was found to underestimate the chronologic age in both genders. A prediction formula based on Cameriere's method specific to Saudi children has been developed for estimating chronologic age. The new regression formula developed will be more accurate for age assessment in Saudi children.
Dental maturity assessment in Serbian population: A comparison of Cameriere's European formula and Willems’ method
2018, Forensic Science International
Citation Excerpt :
Dental age estimation is a procedure that determines age of an individual according to the dental maturity, which is an essential part of age estimation procedure together with general physical examination, gathering available personal information and assessment of skeletal maturity [1].
To test the applicability of European formula for dental maturity estimation in non-adults on Serbian sample and compare its accuracy with Willems’ age estimation method.
Panoramic radiographs of 423 children (192 boys and 231 girls) aged between 5 to 15 were evaluated. Willems’ method and European formula were applied to estimate dental age. Intra-class correlation (ICC) coefficients between estimated age and chronological age for each method and sex were reported separately. Furthermore, the percentage of individuals with estimated age within error range of ±0.5 year was calculated.
Total sample was divided into three groups (<7 years, 7–13 years, ≥13 years). In individuals younger than 7 years, the highest ICC coefficients were achieved with European formula (0.609 in girls and 0.487 in boys). Willems’ method showed better ICC coefficients in individuals older than 13 years (0.378 in girls and 0.600 in boys). In individuals between 7 and 13 years, ICC coefficients were between 0.800 and 0.900 with both methods European formula estimated the age in 47.6% of girls and 42.5% of boys within error range of ±0.5 year. Willems’ method reported similar results (45.4% in girls and 40.4% in boys).
The Willems’ method is more appropriate for individuals older than 13 years. European formula gives better results for individuals younger than 7 years. In individuals between 7 and 13 years there is no significant difference between European formula and Willems’ method, yet, European formula was found to be slightly more accurate.
Comparison of the applicability of Demirjian and Willems methods for dental age estimation in children from the Thrace region, Turkey
2018, Forensic Science International
Dental age (DA) estimation is frequently used in the fields of orthodontics, paediatric dentistry and forensic science. DA estimation methods use radiology, and are reliable and non-destructive according to the literature. The Demirjian method is currently the most frequently used method, but recently, the Willems method was reported to have given results that were more accurate for some regions. The aim of this study was to detect and compare the accuracy of DA estimation methods for children and adolescents from the Thrace region, Turkey. The mean difference between the chronological age (CA) and the DA was selected as the primary outcome measure, and the difference range according to sex and age group was selected as the secondary outcome.
Panoramic radiographs (n = 766) from a Thrace region population (380 males and 386 females) ranging in age from 6 to 14.99 years old were evaluated. DA was calculated using both the Demirjian and the Willems methods.
The mean CA of the subjects was 11.39 ± 2.34 years (males = 11.08 ± 2.42 years and females = 11.70 ± 2.23 years). The mean difference values between the CA and the DA (CA–DA) using the Demirjian method and the Willems method were −0.87 and −0.17 for females, respectively, and −1.04 and −0.40 for males, respectively. For the different age groups, the differences between the CA and the DA calculated using the Demirjian method (CA–DA) ranged from −0.53 to −1.46 years for males and from −0.19 to −1.20 years for females, while the mean differences between the CA and the DA calculated by the Willems method (CA–DA) ranged from −0.19 to −0.50 years for males and from 0.20 to −0.49 years for females.
The results suggest that the Willems method produced more accurate results for almost all age groups of both sexes, and it is better suited for children from the Thrace region of Turkey, than the Demirjian method.

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Original CommunicationThe applicability of Willems' method for age estimation in southern Turkish children: A preliminary study

Highlights

Abstract

Introduction

Section snippets

Material and methods

Results

Discussion

Conclusion

Conflict of interest

Funding

Ethical approval

J Forensic Leg Med

Forensic Sci Int

Forensic Sci Int

Forensic Sci Int

Am J Orthod

Forensic Sci Int

Forensic Sci Int

Leg Med (Tokyo)

Understanding juvenile penal justice in Turkey. The criminalisation of Youth Juvenile Justice in Europe, Turkey and Canada

Comparison of four skeletal methods for the estimation of age at death on white and black adults

J Forensic Sci

A review of the most commonly used dental age estimation techniques

J Forensic Odonto Stomatol

Time and order of eruption of the primary teeth

Odontol Revy

Original Communication
The applicability of Willems' method for age estimation in southern Turkish children: A preliminary study